Post chemo CLL information

[sweetromeet]

My dad is detected with CLL ,fourth stage.the wbc count was 7.2 lacs..after first chemo it went dwn to 2.88 almost.But after second chemo ,it again went up to 5.22 lacs in the first week after chemo.Please suggest and explain why it is happening ?

[AussieNeil Partner Administrator]

The lac/lakh unit is used in India and a few surrounding countries, so using is confusing to most of us without providing the reference range for the respective blood test. Most importantly, with CLL treatment we want to closely monitor two very important blood cell counts that together make up most of the WBC. They are the lymphocyte count and the neutrophil count. The lymphocyte count includes CLL cells so we want it to go down - usually dramatically. Treatments often reduce our neutrophil count, which we don't want affected if possible, because we need neutrophils to fight off infections.

You should be ablet to find these important counts on blood test reports. Ask for copies if don't have them. Sometimes the percentage only of lymphocytes and neutrophils (sometimes called segs) are provided. You can get the absolute counts by mutiplying the WBC by the respective percentage.

What are they please?

Neil

[sweetromeet in reply to AussieNeil]

Nuetrophil count is 2 percent n absolute nuetrophil is 10.44 n absolute lymphocyte is 469.87

[cllady01 Former Volunteer]

Sweetromeet, is your father now on Ibrutinb as your last post suggested he would be?

[sweetromeet in reply to cllady01]

Doc has indicated that he wll put him on ibrutinib after 1st chemo..bt then he changed and continues with rituximab and endoxon for the second one.He is thinking of going to ibrutinib may be by next chemo..bt yet to decide

[AussieNeil Partner Administrator in reply to sweetromeet]

Your father has a high tumour burden as indicated by his high lymphocyte count. I expect he also has a swollen spleen and large internal nodes that his treatment is gradually shrinking? Has his doctor mentioned changes in his spleen and nodes? That could explain why his lymphocyte count has increased - they are being released from his nodes.

Endoxon is better known elsewhere as Cyclophosphamide. A very effective treatment for CLL, provided your father has the right prognostic markers is Fludarabine, Cyclophosphamide and Rituximab, (FCR), or sometimes FR is given, without the Cyclophosphamide, so I wonder why your father is not being given the Fludarabine?

Were his haemoglobin or platelets very low before he started treatment? Cyclophosphamide and Rituximab with Dexamethasone has been successfully used to treat CLL patients with auto-immune haemolytic anaemia (AIHA) or idiopathic thrombocytopenic purpura (ITP).

pubmed.ncbi.nlm.nih.gov/193...

It seems that your father's doctor is using his current treatment to reduce his tumour burden quickly to improve his condition before switching to Ibrutinib, which works more slowly.

Neil

[sweetromeet in reply to AussieNeil]

Yes the doctor has told us about his tumour burden and large internal nodes.Hos platelets were quite low and haemoglobin was 6.5 when he started treatment.His chemo.combi is rituximab and cyclophosphamide and dexa

[AussieNeil Partner Administrator in reply to sweetromeet]

It seems his large tumour burden is probably the reason for what's happening. His treatments should bring down his lymphocyte count over time. Please keep us informed.

Neil

[sweetromeet in reply to AussieNeil]

Thanks a lot...